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Multi-location dental / emerging DSO · 12-month engagement · Illustrative compositeWillamette Smiles rebuilt the new-patient pipeline five locations were missing online.
A 5-location emerging dental DSO where three flagship practices captured almost every new-patient call and the two newest offices were invisible online. Over twelve months Emaration's six-layer audit, a one-time migration sprint, and Content Ops Tier 2 fixed attribution first, then recovered the organic and AI-engine new-patient pipeline across all five locations and surfaced ~6.0× first-year ROI. Composite engagement; the mechanics are real, the outcomes projected from industry benchmarks.
Two of five offices were carrying themselves. Nobody could prove why.
A 5-location emerging dental DSO, $9–14M revenue, general dentistry plus a growing implant and clear-aligner book. Marketing was run by an operations director plus a shared front-desk team across locations. They'd spent two years with a dental-niche agency on a $4,500/month retainer and described the result, verbatim, as "a dashboard full of vanity numbers and two offices we still had to prop up with direct mail."
The owners could feel the upside waiting. Three flagship practices took roughly 70% of all new-patient calls; the two newest offices — opened in the last 18 months — were barely ringing, with chairs, hygienists, and open schedules ready to fill. They couldn't tell whether the cause was the website, the search results, the local listings, or all three. The website tied the brand together — the highest-leverage place to win those calls. Multi-location dental groups have structural problems generalists miss (per-location pages, Dentist + LocalBusiness schema, Google Business Profile mechanics, review-signal routing), AI Overviews now answer 30–40% of informational queries like "how much do dental implants cost" directly (an open citation lane to win), and the prior agency had pointed every location's "find a dentist near me" content at one combined page that cannibalized itself.
Baseline at intake (illustrative)
| Metric | At intake | Source |
|---|---|---|
| GSC clicks / month | 3,100 | Google Search Console |
| GSC impressions / month | 240,000 | Google Search Console |
| GA4 sessions / month | 7,400 | GA4 |
| Organic new-patient conversions / month | 96 | GA4 + call tracking |
| AIO-affected query share | ~36% | Manual SERP analysis |
| Core Web Vitals LCP (p75) | 4.8 s | PageSpeed Insights |
| 404 / 5xx per week | 1,600 | Server logs |
Known data-quality issues found in audit week one: GA4 form-fill conversions undercounted by ~30%, call tracking pooled to a single number so per-location attribution was impossible, and the two newest locations shared a cannibalizing combined landing page that out-ranked their own office pages.
The six-layer audit, then the scoped fix.
Every Emaration engagement starts the same way: a six-layer audit delivered in 10 business days from intake. The fix list, the priority, and the line-item pricing all come out of what the audit surfaces — not a template. Here's how that played out for Willamette Smiles.
The audit ran ten business days. We crawled all five location subdirectories, ran Core Web Vitals on the templates, traced every redirect chain, and validated schema. We ran a multi-prompt probe across ChatGPT, Claude, Perplexity, and Gemini for the queries patients actually type — "emergency dentist open now," "dental implants cost," "Invisalign vs braces," "[neighborhood] family dentist" — and logged where Willamette Smiles was cited, where a competitor was cited, and where the AI engine made something up.
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Technical: redirects + speed
The 1,600/week 404 spike traced to a 2024 site replatform that left ~1,100 legacy URLs un-redirected. One newer office page was noindexed by accident. Mobile LCP was 4.8 s. Fix: 301 matrix, meta-robots correction, redirect-chain consolidation.
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Content vs. competitors
The two newest offices had no dedicated landing content and were cannibalized by one combined page. Built location × service pages (implants, aligners, emergency, pediatric) from the practices' existing patient-FAQ playbooks — voice the offices already used, just indexed per location.
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AI engine visibility (AIO)
High-intent informational queries were being absorbed by AI Overviews. Restructured FAQ blocks with JSON-LD across location pages to recover brand mentions inside AIO responses. Added Dentist + MedicalBusiness + LocalBusiness schema per office.
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Measurement & attribution
GA4 + GTM + call tracking were misaligned and pooled, understating conversions by ~30% and hiding which office earned which call. Deployed server-side GTM and per-location call tracking in month 2. Connected GA4 to BigQuery so the owners could see per-office bookings and cost-per-new-patient without a monthly PDF.
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Vendor economics
Prior agency was charging $4,500/mo for roughly $600/mo of actual delivered work. We rebuilt the scope as a 16-line plan with line-item prices — four lines run by us, two by a vetted white-label SEO partner at cost, the rest in-house with a written checklist.
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Accessibility & trust
Location pages failed screen readers (no alt text on team photos, color-only signaling on the "accepting new patients" and emergency callouts) and the online booking widget wasn't keyboard-navigable. Full WCAG-AA remediation pass in months 2–3. Compounds especially with older implant and denture patients.
Where AI did the work, where humans did the work
AI did this
- Brief generation (intent decomposition + content outlines)
- First-pass drafts from approved briefs
- Anomaly detection against baseline metrics in BigQuery
- Bulk schema markup generation
- Internal-link map suggestions
Humans did this
- Every published piece reviewed for voice, accuracy, and dental-claims compliance
- Schema validation manually checked on each deploy
- Migration sprint hand-built and QA'd by Andrew plus a vetted sub-contractor
- WCAG-AA remediation human-tested, including the booking widget
- Per-deliverable AI disclosure in every monthly report
Cadence was light by design: a 30-minute weekly check-in, a shared Looker dashboard the owners could open any time, and a Monday "what changed, what's queued, what's blocked" note. We explicitly did not do paid media (referred out), social (not a dental-vertical winner at this stage), or online reputation management (referred to a specialist).
What would move, by how much, over twelve months.
Every figure below is projected from published industry benchmarks for multi-location dental groups and Emaration's audit methodology, not measured from a single real engagement. Numbers are illustrative.
| Metric | At intake | Month 6 | Month 12 | Delta |
|---|---|---|---|---|
| GSC clicks / month | 3,100 | 6,400 | 9,200 | +197% |
| GSC impressions / month | 240,000 | 340,000 | 420,000 | +75% |
| GA4 sessions / month | 7,400 | 13,800 | 18,600 | +151% |
| Organic new-patient conversions / month | 96 | 241 | 396 | +312% |
| AIO-affected query share | ~36% | ~30% | ~26% | −10 pts |
| LCP (p75) | 4.8 s | 2.2 s | 1.8 s | −63% |
| 404 / 5xx per week | 1,600 | 110 | 35 | −98% |
| Average position (priority queries) | 9.1 | 4.4 | 2.6 | −6.5 |
Organic new-patient conversions / month (illustrative)
Projected from baseline (96/mo) to month 12 (396/mo). Illustrative.
AI-engine citation share — before / after
Before vs. day-90 illustrative probe, local + service-intent queries. Projection.
Time to first measurable win in this composite: ~3 weeks (post-migration sprint, 404 volume drops ~93%, GSC clicks rebound within 14 days). What was harder than projected: untangling the pooled call-tracking number so each office got credit for its own calls, and one newer location that needed a full page rebuild rather than a fix-in-place. What was easier: per-location Dentist schema plus FAQ restructuring produced brand-mention recovery faster than the model assumed.
What it would cost. What it would return. What goes to charity.
| Item | Amount |
|---|---|
| Onboarding audit (deliverable yours to keep) | |
| Migration sprint (one-time) | $9,000 |
| Content Ops Tier 2 — $5,000/mo over year 1 | $60,000 |
| Year-1 total client investment | $69,000 |
| Projected Year-1 incremental new-patient revenue | ~$414,000 |
| Projected Year-1 ROI | ~6.0× |
Revenue model: +300 incremental monthly new-patient conversions × $115 average first-year value per new patient (conservative blended new-patient value across the practice service mix). Numbers are illustrative until measured.
What Willamette Smiles got that the prior agency wasn't delivering.
| Thing | Prior agency | Emaration |
|---|---|---|
| Monthly reports they could actually read | Vague | Scorecard + per-office baseline + anomalies + voice notes + what's queued |
| Per-location attribution | Pooled to one number | Per-office call tracking + sGTM; conversion undercount fixed |
| Vendor cost disclosure | None | Sub-processor list public; vendor cost in monthly report |
| AI disclosure | None ("we use AI tools") | Per-deliverable: what AI did, what humans did |
| Accessibility | Ignored | WCAG-AA remediation incl. booking widget; AI imagery only with visible disclosure |
| Friction question at QBR | Never asked | Asked verbatim at M3, M6, M9, M12 |
| Charitable receipt | None | Monthly EOCS receipt with named programs funded |
What would change for the team running the group.
"For the first time I can see which office earned which new patient. Our two newest locations went from quiet to offices that fill their own schedule. And the report tells me what their AI did, what their humans did, and what they paid their vendors — I didn't know I was allowed to expect that."
— Composite operations-director voice, assembled for illustrative use only. Replaced with a verbatim, written, signed real-client quote the moment a real engagement closes.
What this engagement would fund.
Emaration commits 10% of net profit to Emaration's Outreach and Community Support (EOCS) — the charitable arm Jordan leads. Every client engagement carries a per-engagement receipt the client can see and share.
Projected Year-1 EOCS contribution from this composite engagement
~$6,000 — calculated as 10% of net profit attributable to this engagement (Year-1 Emaration COGS ~$9,000 against $69,000 client investment, ~87% gross margin, EOCS share applied to net).
Programs funded (illustrative):
- A free community dental-health-day microsite for a Portland-area free clinic
- One accessibility audit for a regional oral-health nonprofit
EOCS amounts and named programs in published receipts will be verified from real engagement financials, not modeled. The figures above are illustrative.
What will be in this case study when a real engagement replaces it.
When this composite is retired, the real version will publish: redacted GSC delta screenshots, the real GA4 chart export, a read-only Looker Studio link, an audit PDF excerpt, the deliverables inventory log, the real signed-and-dated EOCS receipt with named programs funded, and the verbatim, written, signed client quote — with consent per Emaration's case study template.
Retirement criteria: (1) a real multi-location dental engagement that has run at least 90 days, (2) real baseline + delta metrics, (3) written client consent to publish, (4) a real verbatim client quote. Replace this file, do not edit it.
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